Beruflich Dokumente
Kultur Dokumente
2d 186
Medicare&Medicaid Gu 33,639
Jane DOE, et al., Plaintiffs-Appellants,
v.
Barbara BLUM, individually and as Commissioner of the New
York State Department of Social Services, et al.,
Defendants-Appellees.
No. 449, Docket 83-6034.
Lynn Martell, New York City (Janet M. Calvo, Washington Square Legal
Services, Inc., New York City, on the brief), for plaintiffs-appellants.
Stanley A. Camhi, Asst. Atty. Gen., New York City (Robert Abrams,
Atty. Gen., Melvyn R. Leventhal, Deputy First Asst. Atty. Gen., New
York City, on the brief), for defendant-appellee Barbara Blum.
Margaret G. King, New York City (Frederick A.O. Schwarz, Jr., Corp.
Counsel, Michael Gage, New York City, on the brief), for defendantappellee James Krauskopf.
Jane E. Booth, Asst. U.S. Atty., New York City (Rudolph W. Giuliani,
U.S. Atty., Michael H. Dolinger, Asst. U.S. Atty., New York City, on the
brief), for defendant-appellee Margaret M. Heckler.
Before TIMBERS, VAN GRAAFEILAND and NEWMAN, Circuit
Judges.
JON O. NEWMAN, Circuit Judge:
sexually active teenagers, appeal from the December 16, 1982, judgment of the
District Court for the Southern District of New York (Vincent L. Broderick,
Judge) dismissing their complaint against state and city welfare administrators
for failure to state a legally sufficient claim for relief.1 Plaintiffs' principal
claim is that by giving a Medicaid identification card and sending family
planning services information only to the head of a household, state and city
defendants are violating various provisions of the Social Security Act, 42
U.S.C. Sec. 301 et seq. (1976 & Supp. V 1981), and the Constitution. For
reasons that follow, we affirm the dismissal of the complaint.
2
* Plaintiffs reside in households that receive AFDC benefits and are thereby
eligible for Medicaid assistance. In their amended complaint, they allege that
they (1) are sexually active and desire information about family planning and
abortion services under the Medicaid and AFDC programs, (2) have never
received that information, (3) have never been informed by the respective
heads of their households of their entitlement to Medicaid reimbursed family
planning services and supplies, and (4) are unable to use any of the family
planning services and supplies because they do not have their own Medicaid
identification card and cannot obtain the use of their parents' card.2
Plaintiffs claim that the New York state and city practice of issuing Medicaid
cards and distributing family planning services information to the head of a
household, rather than directly to all sexually active members of a household,
violates the requirements of the Social Security Act ("Act") that "in all
appropriate cases" family planning services and information be "offered" and
"provided" to sexually active AFDC and Medicaid recipients of child bearing
age. 42 U.S.C. Sec. 602(a)(15)(A) (Supp. V 1981) (AFDC); 42 U.S.C. Secs.
1396a(a), 1396b(a)(5), and 1396d(a)(4)(C) (1976 & Supp. V 1981) (Medicaid).
Plaintiffs also claim that mailing information to heads of households but not all
household members violates the Equal Protection Clause and that the failure to
give them their own Medicaid identification card provides the head of the
household with a veto over their sex-related health care decisions, creating, in
effect, a parental notice and consent requirement that violates the First, Fourth,
Ninth, and Fourteenth Amendments of the Constitution.
For relief against the state and city defendants, plaintiffs seek a declaratory
judgment that defendants' administration of their family planning services
program violates the Act and the Constitution and a mandatory injunction
requiring defendants to provide each eligible individual with her own Medicaid
identification card and an individual copy of written information concerning
family planning services.
Plaintiffs also contend that the federal defendant has failed to compel New
York to administer its programs in compliance with federal law. They seek a
mandatory injunction and a declaratory judgment that would require the federal
defendant to change her interpretation of the Act, to demand New York's
compliance with that Act, and to reduce New York's federal AFDC funds by
one per cent unless it complies with the Act and the relevant regulations.II
We turn first to the state and city defendants' challenge to plaintiffs' standing to
assert the claims raised. The District Court adverted to "a very serious question
as to the standing of the plaintiffs," but proceeded to the merits of the claims
because "to the extent that the complaint sets forth that the plaintiffs receive no
notice of the availability of family planning services," the lack of notice "itself
[is] an allegation of injury" that gives them standing. Defendants challenge
plaintiffs' standing on the grounds that no plaintiff alleges that she applied for,
and was denied, family planning services.
In testing plaintiffs' standing, we must consider (1) whether they allege that
they have suffered an "injury in fact" and (2) "whether the interest sought to be
protected by the complainant[s] is arguably within the zone of interests to be
protected or regulated by the statute or constitutional guarantee in question."
Association of Data Processing Service Organizations, Inc. v. Camp, 397 U.S.
150, 152-53, 90 S.Ct. 827, 829-30, 25 L.Ed.2d 184 (1970); see Barlow v.
Collins, 397 U.S. 159, 164-65, 90 S.Ct. 832, 836-37, 25 L.Ed.2d 192 (1970).
While injury in fact is essential to an Article III case or controversy, Warth v.
Seldin, 422 U.S. 490, 498-99, 95 S.Ct. 2197, 2204-05, 45 L.Ed.2d 343 (1975),
the zone of interest requirement reflects prudential considerations. Valley Force
Christian College v. Americans United for Separation of Church and State, Inc.,
454 U.S. 464, 474-75, 102 S.Ct. 752, 759-60, 70 L.Ed.2d 700 (1962).3 We have
no doubt that the interests plaintiffs seek to protect are within the "zone of
interests" intended to be furthered by the statutory scheme. Plaintiffs allege that
they are sexually active eligible recipients who desire access to family planning
services. The relevant statutory provisions were enacted to reduce the incidence
of unwanted pregnancy and venereal disease among indigent sexually active
teenagers and adults. See, e.g., H.R.Rep. No. 544, 90th Cong., 1st Sess. 4
(1967), reprinted in 1967 U.S.Code Cong. & Ad.News 2834, 2835.
(1973); Linda R.S. v. Richard D., 410 U.S. 614, 617, 93 S.Ct. 1146, 1148, 35
L.Ed.2d 536 (1973). Plaintiffs have alleged a sufficient injury with respect to
their claim that New York fails to notify them of the availability of family
planning services, a failure they contend violates the statutory requirement of
an "offer" and denies them equal protection. The lack of notice is the injury, as
the District Court recognized, and plaintiffs have standing to complain of that
injury whether or not they have been denied services.
9
Plaintiffs lack standing, however, for their remaining claims. None of the
plaintiffs alleges that she requested and was denied family planning services for
want of a Medicaid identification card. Consequently, none has standing to
assert either the statutory claim that New York fails adequately to provide those
services or the constitutional claim that lack of an individual Medicaid
identification card permits the head of a household to preclude household
members from obtaining such services and thereby to intrude upon their sexrelated health care decisions. Cf. Warth v. Seldin, supra (potential residents of
community lack standing to challenge alleged exclusionary zoning practices).
Even after an opportunity to amend their complaint, see id. 422 U.S. at 501, 95
S.Ct. at 2206, none of the plaintiffs alleged any attempt to obtain services
without a Medicaid identification card or the denial of those services.4
III
10
We turn now to the merits of plaintiffs' claim that the state practice of sending
family planning services information only to the head of a household, rather
than to all sexually active members of that household, violates various
provisions of the Act. This claim raises two distinct issues--whether the Act
imposes any notification requirement and, if so, whether, plaintiffs' allegations
state a claim of non-compliance with such a requirement. We agree with the
District Court that any requirement to provide individualized notification exists,
if at all, only by virtue of section 402(a)(15)(A) of the Act,5 which provides in
part that state plans6 for the administration of AFDC must provide:
11 the development of a program, for each appropriate relative and dependent child
for
receiving aid under the plan and for each appropriate individual (living in the same
home as a relative and child receiving such aid) ... for preventing or reducing the
incidence of births out of wedlock and otherwise strengthening family life, and for
implementing such program by assuring that in all appropriate cases (including
minors who can be considered to be sexually active) family planning services are
offered to them and are provided promptly (directly or under arrangements with
others) to all individuals voluntarily requesting such services but acceptance of
family planning services provided under the plan shall be voluntary on the part of
such members and individuals and shall not be a prerequisite to eligibility for or the
receipt of any other service under the plan.
12
13
14
In our view the wording of the statute is not conclusive. Though it is a familiar
canon of construction that all words of a statute are to be given meaning, it is a
reality that the drafters of statutes (no less than the drafters of opinions)
sometimes use two words where one would suffice. "Offer" in section 402(a)
(15)(A) does not necessarily mean something different from "provide."
Moreover, as a textual matter, the terms "offered" and "provided promptly"
could be given slightly distinct meanings, without any implication of a notice
obligation, by reading them to mean that services must be available to all
eligible persons and furnished promptly to those who request them. Even if
"offered" connotes some degree of notice, the word surely does not convey
meaning as to the extent of such notice. We therefore examine the legislative
history for guidance as to what Congress intended.
15
16
(A) for the development of a program for each appropriate relative and
dependent child receiving aid under the plan, and each appropriate individual
(living in the same home as a relative and child receiving such aid) whose
needs are taken in account in making the determination under clause (7), with
the objective of-***
17
18 preventing or reducing the incidence of births out of wedlock and otherwise
(ii)
strengthening family life,
19
20 assuring that such relative, child, or individual who is referred to the Secretary of
(i)
Labor pursuant to clause (19) is furnished child-care services and that in all
appropriate cases family planning services are offered to them....
21
Pub.L. No. 90-248, Sec. 201(a)(1)(C), 81 Stat. 821, 878 (1967) (emphasis
added). Were we construing that provision, the plain meaning would provide
scant support for a notification requirement. Moreover, there is no reference in
the legislative history to any obligation to inform. See S.Rep. No. 744, 90th
Cong., 1st Sess., reprinted in 1967 U.S.Code Cong. & Ad.News 2834, 2837,
2869, 2983, 3033, 3116; H.R.Rep. No. 544, 90th Cong., 1st Sess. 4, 16, 97-98,
171-72 (1967).7
22
In 1971, section 402(a)(15)(A) was further amended by adding the clause: "but
acceptance of family planning services under the plan shall be voluntary on the
part of such members and individuals and shall not be a prerequisite to
eligibility for or the receipt of any other services under the plan." Pub.L. No.
92-223, Sec. 3(a)(1), 85 Stat. 802, 803 (1971). That addition lends no weight to
plaintiffs' construction, and the accompanying committee reports do not even
mention this amendment. See H.R.Rep. No. 590, 92d Cong., 1st Sess. (1971);
S.Rep. No. 552, 92d Cong., 1st Sess., reprinted in 1971 U.S.Code Cong. &
Ad.News 2435.8
23
The 1972 Amendments to the Social Security Act included several changes
concerning the coverage and provision of family planning services and added a
penalty for non-compliance by the states in providing such services. Pub.L. No.
92-603, Sec. 299E, 86 Stat. 1329, 1462-63 (1972). The amendments to section
402(a)(15)(A) itself add little, if any, support to plaintiffs' construction. One
change inserted after the words "offered to them" the clause "and are provided
promptly (directly or under arrangements with others) to all individuals
voluntarily requesting such services." This addition of a "prompt provision"
requirement suggests only that Congress was concerned with the delay in the
The non-compliance penalty provision and its legislative history give some
support to plaintiffs' construction. The Senate proposed an amendment to the
House bill to reduce by two per cent the amounts payable to a state "if such
state, in the immediately preceding fiscal year, failed to carry out fully the
provisions of section [402(a) ] requiring the offering and provision of family
planning services and supplies." S.Rep. No. 1230, 92d Cong., 2d Sess. 834
(1972). The House accepted that amendment but lowered the penalty to one per
cent. Conf.Rep. No. 1605, 92d Cong., 2d Sess., reprinted in 1972 U.S.Code
Cong. & Ad.News 4989, 5399. The provision as enacted states, in part, that the
amounts payable to states shall be reduced by one per cent if such state "in the
immediately preceding fiscal year failed to carry out the provisions of section
402(a)(15)(B)10 of this title as pertain to requiring the offering and arrangement
of provision of family planning services." Pub.L. No. 92-603, Sec. 299E, 86
Stat. 1329, 1463 (1972) (codified at 42 U.S.C. Sec. 603(f)(1) (1976)).
25
Though the wording of this penalty provision does not illuminate the meaning
of "offer," the legislative history provides some support for an obligation of
undefined magnitude to inform AFDC recipients of the availability of family
planning services. The Senate Report states that the Senate-proposed penalty
provision would "reduce the federal share of AFDC funds by 2 percent ... if a
State in the prior year fails to inform the adults in the AFDC families and on
workfare of the availability of family planning services and/or if the State fails
to actually provide or arrange for such services for persons desiring to receive
them." S.Rep. No. 1230, 92d Cong., 2d Sess. 67 (1972) (emphasis added). The
Report also states:
26
In order to assure that States do in fact inform welfare recipients and other
eligible persons of the availability of family planning services, and that those
who so desire receive the necessary medical and counseling services, the
amendment would reduce the Federal share of AFDC funds by 2 percent,
beginning with calendar year 1974, if a State in the prior year fails to inform at
least 95 percent of the adults in AFDC families and on workfare of the
availability of family planning services and/or if the State fails to actually
provide or arrange for such services for 100 percent of those persons desiring to
receive them.
27
28
29
30
Id. at 297.
31
This Report and the Conference Committee Report 11 appear to envision some
informational obligation, at least as to adult AFDC recipients. But even if the
92d Congress thought that the obligation to "offer" services, as enacted by the
90th Congress, included some notification requirement,12 arguably the
legislators envisioned no more than a system whereby welfare office personnel
would inform eligible recipients of the availability of services during the course
of an application interview. The Senate Report states that a penalty will be
imposed if the state "fails to inform at least 95 percent of the adults in AFDC
families." S.Rep. No. 1230, 92d Cong., 2d Sess. 297. This language suggests
that any informational obligation extends only to AFDC applicants, rather than
to all the household members for whom benefits may be available. Moreover,
in light of the inherent enforcement problems, it is unlikely that Congress
contemplated a public relations campaign of the magnitude plaintiffs request.
Not only would a state have difficulty locating all minors who could be
considered sexually active, but the Secretary would have difficulty policing the
95 per cent compliance rate referred to in that Report.
32
Although this dispute between plaintiffs and the state and local defendants is
the type in which the Secretary's interpretation of the statute would be entitled
34Offer --An offer of family planning services occurs when a person is informed of
2.
the availability of these services and the means for obtaining them. The offer must
be made to current recipients in writing. The requirement of a written offer may be
met by a flyer, one to a family, with the assistance check. A record must be
maintained of the offer. The offer must be made within 31 days of the first
assistance payment or by April 1, 1974, whichever is later, and once a year
thereafter.
35
36
38
The Secretary of Health and Human Services moved to dismiss the complaint
for lack of subject matter jurisdiction on the grounds that there was no
jurisdiction under 28 U.S.C. Sec. 1331 (1982), 28 U.S.C. Sec. 1361 (1982), the
Administrative Procedure Act, 5 U.S.C. Sec. 701 et seq. (1983), or the Social
Security Act. Because the District Court granted the state and city defendants'
motions to dismiss the complaint and the claims against the federal defendant
were derivative in nature, the District Court also dismissed the complaint as to
the federal defendant without considering the alleged jurisdictional defects.
Since we affirm the ruling on the insufficiency of the primary claim, we also
see no need to consider the jurisdictional basis of the derivative claim
Recent Supreme Court decisions that do not advert to the "zone of interest" test,
see, e.g., INS v. Chadha, --- U.S. ----, 103 S.Ct. 2764, 77 L.Ed.2d 317 (1983);
Duke Power Co. v. Carolina Environmental Study Group, Inc., 438 U.S. 59, 98
S.Ct. 2620, 57 L.Ed.2d 595 (1978), have prompted doubts about the continued
vitality of the zone of interest requirement. See, e.g., B.K. Instrument, Inc. v.
United States, 715 F.2d 713, 719 (2d Cir.1983); 4 K.C. Davis, Administrative
Law Treatise Sec. 24:17 (1983)
The class action allegation adds nothing to the standing inquiry since the named
plaintiffs "must allege and show that they personally have been injured, not that
injury has been suffered by other, unidentified members of the class to which
they belong and which they purport to represent." Warth v. Seldin, supra, 422
U.S. at 502, 95 S.Ct. at 2207; see O'Shea v. Littleton, 414 U.S. 488, 494, 94
S.Ct. 669, 675, 38 L.Ed.2d 674 (1974)
The parallel provision for state Medicaid plans, enacted in 1972, Pub.L. No. 92603, Sec. 299E, 86 Stat. 1329, 1462, simply defines "medical assistance" in 42
U.S.C. Sec. 1396a(a) (Supp. V 1981) to include "family planning services and
supplies furnished (directly or under arrangements with others) to individuals of
child-bearing age (including minors who can be considered to be sexually
active) who are eligible under the State plan and who desire such services and
supplies." 42 U.S.C. Sec. 1396d(a)(4)(C). Another provision, 42 U.S.C. Sec.
1396b(a)(5), states that federal reimbursement for state Medicaid program
expenditures shall include "an amount equal to 90 per centum of the sums
expended during such quarter which are attributable to the offering, arranging,
and furnishing (directly or on a contract basis) of family planning services and
supplies."
Under both the AFDC and Medicaid provisions, participating states are
required to submit plans for approval to the Secretary of Health and Human
Services, 42 U.S.C. Secs. 602 and 1396 (1976 & Supp. V 1981). These plans
must conform to the requirements of the Social Security Act and the regulations
promulgated thereunder. 42 U.S.C. Secs. 602 and 1396a; King v. Smith, 392
U.S. 309, 317, 88 S.Ct. 2128, 2133, 20 L.Ed.2d 1118 (1968). If a state fails to
administer its program in "substantial compliance" with the Act, the Secretary
may withhold payments under the program. 42 U.S.C. Secs. 604(a) and 1396c.
If a state fails to offer and arrange for the provision of family planning services
under its AFDC plan, the Secretary may reduce AFDC payments to the state by
one per cent. 42 U.S.C. Sec. 603(f)
Plaintiffs rely on the floor remarks of then Congressman Bush, a member of the
Committee on Ways and Means, which reported the bill. After noting the
proposed "requirement that all states offer family planning services to mothers
The House, Senate, and Conference Committee Reports shed little light on the
significance of these two additions. The "sexually active minors" parenthetical
is not expressly referred to in any of those reports. In the section of the Senate
Report pertaining to new provisions added by the Finance Committee, that
Committee states "The Secretary would be required to work with the States to
assure that particular effort is made in the provision of family planning services
to minors (and non-minors) who have never had children but who can be
considered to be sexually active; for example, persons who have contracted
venereal diseases, etc." S.Rep. No. 1230, 92d Cong., 2d Sess. 297 (1972).
However, the revisions of the House bill proposed by the Senate Committee
did not include the "sexually active" parenthetical. See id. at 818
The "provided promptly" clause originated in a Senate amendment to the House
version of the bill, see S.Rep. No. 1230, 92d Cong., 2d Sess. 818 (1972), and
there is no reference to the clause in either the Senate or Conference Committee
Reports.
10
Since the cross-reference is to "provisions ... requiring the offering ... of family
12
Judge Wald has observed that "follow-up congressional intent may become
relevant if expressed in a positive legislative act." Wald, Some Observations on
the Use of Legislative History in the 1981 Supreme Court Term, 68 Iowa L.R.
195, 205 (1983)
13
Although the Social and Rehabilitation Service has been abolished and its
functions transferred, the "Program Instruction" was not rescinded
14
15
Plaintiffs made no claim that state or local officials refused to discuss available
family planning services with any of them or denied any request for
information to be conveyed by mail or by telephone